Healthcare Provider Details

I. General information

NPI: 1346780137
Provider Name (Legal Business Name): FAMILY AND INDIVIDUAL THERAPEUTIC HEALING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2017
Last Update Date: 02/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1145 TALL GRASS CIR #202
STOW OH
44224-6936
US

IV. Provider business mailing address

3926 CLOCK POINTE TRL SUITE 103
STOW OH
44224-6965
US

V. Phone/Fax

Practice location:
  • Phone: 330-280-0716
  • Fax:
Mailing address:
  • Phone: 330-529-2002
  • Fax: 330-529-2002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberE0800007SUPV
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number011296
License Number StateOH

VIII. Authorized Official

Name: DR. LISA MARIE GIOVANNELLI
Title or Position: OWNER
Credential: PHD
Phone: 330-280-0716